In August, 2019, a close friend lost her brother, who became yet another statistic in the ongoing crisis regarding opioid and other drug use in America.  I had met him previously and his death seemed surreal at the time. In fact, it still does.   His parents had never experienced anything like it and did what they could to get him the help that he needed.   For them and thousands of other parents who have lost a child to drugs, they often wonder how did this happen?  And what could we have done to stop it?  There are many answers to both questions but in this eye-opening book, Sam Quinones tackles the first question and tells the story of the development of the opioid epidemic in America.

Purdue Pharma, the company that reaped billions of dollars in the manufacture and sale of OxyContin, filed for bankruptcy in September, 2019, as it settled scores of claims former opioid addicts and family members of those who perished while addicted to the drug.  As part of its bankruptcy filing, it will pay out billions of dollars to those who fell victim to the company’s false adveritsing.   However, it is not the first time Purdue Pharma paid out money in litigation. Quinones revisits the year 2007, in which former U.S. Attorney for the Western District of Virginia John Brownlee launched an investigation into the company’s advertising practices. Purdue later entered into a plea deal with the government in which it agreed to pay a $634.5 million dollar fine. Several of its top executives later served time in prison.

When we think of the opioid epidemic, many ideas come to mind of the drugs that people take the alleviate pain and in other cases, feed an addiction that has become a raging monster.   Some users rely on prescription drugs while others have turned to street drugs, the most popular of which is heroin.   I personally knew someone who succumbed to heroin and each time I think of how short his life was, I shake my head in disbelief.   But I also realize that he was not himself and was caught in the grip of a drug that changes the way the mind and body functions.  We know these drugs exist, but the question is why?

Quinones presents a premise for the book which answers why we have opioids to begin with. Doctors have long sought a way to relieve pain for patients without casuing  addiction.  In short, they were searching for what Quinones calls the “holy grail”, a nonaddictive pain killer.   But to understand the current crisis, we first must learn how opioids were developed and the author provides a back story to their development.  The origins of heroin, methadone, diacetylmorphine and morhpine are discussed.  As I read the book, I thought to myself that the doctors who discovered these drugs most likely had no idea what they would become in years after their deaths.  If they had, perhaps one of more of them would have tried to halt its production.  We shall never know.

The story at hand is really two separate account of opioids, both legal and illegal.  Quinones weaves both into one story but alternates between the two as the book progresses. One part of the story begins with prescription pain killers in the medical field, whose development was quite low until phyiscians Dr. Russell Portenoy and Dr. Kathleen Foley published a paper in 1981 which did not find a direct link to opioid use and later addiction.  The pharmaceutical industry took notice and the town of Portsmouth, Ohio began to feel the effects from a wave of drugs that later changed an entire country.  Portsmouth had once been a thriving city in small town America and Quinones provides a well-written and informative section devoted to its rise and decline, with particular focus on its once mega-sized pool called dreamland.  The small town’s story forms part of the rust-belt narrative featured prominently throughout the rest of the book.

The other part of the story begins in Mexico where we visit the town of Xalisco in the State of Nayarit.   Some readers may be unfamiliar with the town and I personally did not know of its importance to the drug epidemic.  Quinones explains life in this small town, based largely in part of his time living in Mexico.  As the story of the Xalisco becomes more important,  I began to ask myself the same questions as law enforcement personnel: how did this small Mexican town flood the United States with heroin?  The story is actually quite simple and Quinones re-assembles the pieces of the puzzle so readers can see how the infiltration in America’s suburbs began, targeting a generation of young white suburban kids. It is a part of the war on drugs that many still do not fully understand but this book certainly removes all doubt.  The ghost of trafficker David Tejada and others continues to haunt the lives of kids addicted to black tar heroin which has caused the deaths of thousands of young men and women.

The pharmaceutical industry has become a behemoth in the manufacture and distribution of pain killers.  Purdue Pharma, which has been embroiled in controversy, traces its origins back to the legacy of Arthur Sackler (1913-1987), whose family was also named as a defendant in the lawsuit that resulted in its recent bankruptcy filing.  It is imperative to understand Sackler’s influence and Quinones delivers the goods.  In addition to Sackler, there are many others who played a crucial role in the development of prescription pain killers with varying degrees of influence including Dr. Hershel Jick and his then assistant Jane Porter Boston Collaborative Drug Surveillance Program,  Dr. Nathaniel Katz and quack phsyician Dr. David Procter, who could be described as the father of the pill mill.

On the other side of the battle there were many who realized early that something was brewing and that America was in trouble.  Law enforcment officers began to notice a new trend in drug use across small town America but sadly, many of these departments had never been exposed to narcotics of that caliber. And it is an issue which the author explains quite well.  Heroin and other dangerous drugs were never thought of something suburban kids did, it was only what the “city people” did.  However, its introduction into the American heartland changed all perceptions and people soon realized that the drug spares no one. It does not care about wealth, gender, ethnicity or anything else. Its sole purpose is to addict the user.  Drs. Jennifer Sable, Ed Socie and Gary Franklin had begun to sound the alarm bells with the help of pharmacologist Jaymie Mai but many years would pass before those in power too notice.  And years before Purdue came crumbling down, another lawyer named Joe Hale had attempted to bring the company to justice.  The stories of these men and women whose efforts did not go in vain are covered here and Quinones has done a great service to them in showing readers that there were those fighting the battle many years ago.

To say that this book is incredible would be an understatement. It is at times surreal and at others, infuriating.  Greed and negligence combined to spread a wave of deadly addiction across an entire country.  And the failed war on drugs was equally responsible.  Quinones has presented an irrefutable account of the opioid epidemic and its stranglehold on the nation.  For the families of victims such as Matt Schoonover, the pain never ends.  And I think of Francisco Baez, whom I knew very well until his death at the young age of twenty-four.  Their stories are just a sample of the thousands of opoid related deaths every year in America.  And parts of the country which never knew hard drugs are being forced to reckon with a new demon that destroys everything in its path.  This story is an American tragedy but it allows us to see how and why America turned into dreamland.  Excellent read.

ISBN-10: 1620402505
ISBN-13: 978-1620402504